‘Red dot identification system’ can help resolve family issues: Practitioners
- Forensic community urges expansion of Mithuru Piyasas to hospitals
By Ruwan Laknath Jayakody
The red dot identification system (RDIS), which was introduced in order to assist victims of gender-based violence (GBV) including family members, can also be useful to reduce family issues such as violence, drug and alcohol abuse, child and child sexual abuse-related issues, children with social, sexual, and mental health problems, and attempted suicides, noted local medical practitioners, who further stated that this system should be expanded to hospitals islandwide.
This observation and recommendation were made in a concept paper on the “RDIS for Mithuru Piyasa to resolve social problems with medico-legal significance” authored by K.M.T.B. Gunathilake (attached to the Avissawella Base Hospital’s Office of the Judicial Medical Officer [JMO]) and National Child Protection Authority (NCPA) Chairman Prof. M. Vidanapathirana (attached to the Sri Jayewardenepura University’s Medical Sciences Faculty’s Forensic Medicine Department) and published in the Medico-Legal Journal of Sri Lanka’s Sixth Volume’s First Issue in June 2018.
Countering gender-based violence
The Mithuru Piyasa of the Family Health Bureau (FHB) seeks to help victims of GBV under a system called the RDIS which was introduced in order to identify the causative agent or “red dot” of GBV.
In Sri Lanka, the prevalence of GBV, Gunathilake and Prof. Vidanapathirana observe, is neither exceptionally low nor high, and cite V. Jayasuriya, K. Wijewardena, and P. Axemo’s “Intimate partner violence of women in the Capital Province of Sri Lanka: Prevalence, risk factors, and help seeking” which studied married women between the ages of 18 and 49 years in the Western Province, and found a lifetime prevalence of physical violence of 34.4%, sexual violence of 4.2%, and emotional abuse of 19%, which meets the World Health Organisation’s (WHO) average global estimate of one in three women experiencing physical and/or sexual violence by a partner or non-partner, as support for their claim.
GBV, it is observed, also contributes to deaths by suicide. Sri Lanka has one of the highest rates of suicide in the world and during the 2008 to 2015 period, the number of annual suicides remained around 3,000 to 4,000 with approximately 2,500 per annum being among those who were married, according to the Police Crimes Statistics. Gunathilake and Prof. Vidanapathirana posited that these statistics suggest that the reasons for suicide may lie within the family and may include harassment by the husband, sexual incapacity, mental disorders, disappointment and frustration over love affairs, addiction to drugs and alcohol (according to the WHO, Sri Lanka has moderate alcohol consumption with 3.7 litres per individual per year while 116 survivors of wife battery who presented at the Colombo South Teaching Hospital in Kalubowila reported that 60% of husbands regularly consumed alcohol), sexual harassment and rape, ill treatment by children, problems related to elders, and economic problems in the family.
That said, since these conditions were not the causes of GBV, in order to resolve the problems of survivors of GBV, Gunathilake and Prof. Vidanapathirana explained that remedies should be arranged not for the outcome but to control the reasons for suicide, family violence, or drug addiction, and hence, the early identification of the responsible person or the “red dot”, in certain instances, is important when it comes to managing such issues and solving incidents of GBV that take place within the context of the family.
Expanding Mithuru Piyasa
In this regard, there has to be a place where the victims can go to complain about their problems, request for relief, identify the problems, and obtain a reasonable answer. The issue however is that while there are many officers who are dedicated to helping victims in such circumstances, they are housed in different locations with little to no interrelationship between such professionals. In order to identify GBV victims, their problems and the “red dot” if such is available, early, there needs to be a proper referral done, and counselling along with, if required, treatment (drug), should be commenced so as to prevent further family conflicts and suicides. Hence, a place such as the Mithuru Piyasa is essential in every hospital.
Moreover, the Mithuru Piyasa should be expanded to provide a better and wider service to victims and to help prevent intimate partner violence, suicide, child abuse, and drug abuse, and to resolve other problems within the context of the family. Therefore, it is important to identify the contributory factor or the “red dot” if such is available.
To emphasise this need, Gunathilake and Prof. Vidanapathirana presented five cases from among 2,328 persons who visited a Mithuru Piyasa of a provincial general hospital in 2016 to seek help where even though all concerned family-related problems, in certain instances, it was found that there was an individual or “red dot” who had instigated all those problems.
A father suspected that his child’s sexualised behaviour could be due to the observation of acts of the child’s mother’s extra-marital partner. The mother, on the other hand, identified that the grandmother abused the child. The “red dot” was identified to be the grandmother.
An eight-year-old was referred with his mother. The mother faced frequent desertion by her partners and had neglected the child. The reason for the desertions was her schizophrenia (affects, distorts, and interferes with the way a person thinks, perceives reality, feels, expresses, manages emotions, acts and behaves, makes decisions, and relates to others while also impacting their sense of self and the use of language) following postpartum psychosis (characterised by extreme difficulty in responding emotionally to a newborn baby). The “red dot” was identified to be the mother. Treatment was commenced for the mother and the family problems were subsequently resolved.
Two daughters, aged 14 and 15 years, used to sleep in the same bed as their mother and subsequently, the father had developed morbid jealousy. Later, the mother had become depressed and her libido had deteriorated. Further, the father had become violent towards the daughters. The “red dot” was identified to be the daughters, and afterwards, the problems of the family were resolved.
A family with four children where the couple had been married for four years was referred by the Police. The husband had always suspected his wife of having affairs and followed her, and most of the time, the duo had ended up fighting. On occasion, he would keep a 10 kg bag of rice on her head and ask her to kneel for long periods. Their relationships with their neighbours and relatives were also severely disturbed as whenever any neighbour or a family member tried to develop a relationship, the man resorted to his suspicions and attempted to argue and quarrel. The “red dot” was identified to be the husband. Treatments were commenced and the parents were requested to sleep separately and the problems of the family were thereby resolved.
A child was presented following assaults by neighbours. The parents were about to divorce. The child had attention deficit hyperactivity disorder. The “red dot” was identified to be the child. Treatments were started and subsequently, the family problems were resolved.
Resolving issues and challenges involved
Once a family or a client attends the Mithuru Piyasa, the first step is to allow them to talk freely where the counsellor will actively listen to their stories. Then they identify, if available, the problematic person in the family or the “red dot”. In most of the cases, the wife or the person who is admitted to the hospital with suicidal attempts is not the “red dot” of the problem but the victim who suffered due to the activities of the “red dot”.
In such a situation, Gunathilake and Prof. Vidanapathirana proposed that the main management should be based on the “red dot” without considering the “red dot” as a perpetrator but as a victim of the social problem of GBV. Hence, the objective is not to find the perpetrator or to find fault with anyone, but to find the “red dot” and provide both counselling and treatment. Moreover, the Mithuru Piyasa does not make complaints to the Police regarding perpetrators.
There are various challenges to this process. For example, when the “red dot” is identified as a person with a mental disease, informing and getting them down for further treatment and management is a challenge. In such an instance, the officers interview both the husband and the wife, and counsel the normal party first and educate them on the necessity of managing the affected party. The officers also give the normal partner at least a placebo while the affected party is treated with drugs prescribed by the relevant psychiatrist.
Another issue is that those who are identified as having a mental illness are reluctant to accept treatment. With regard to such difficult patients, the Mithuru Piyasa has a dedicated phone line. The officers also educate the normal party to inform them about the progress. Subsequently, a field visit and a review is arranged and a counsellor is sent to the “red dot’s” home.
As pointed out by Gunathilake and Prof. Vidanapathirana, another major issue was the delayed presentation to the Mithuru Piyasa. In this regard, in “Intimate partner violence in Sri Lanka: A scoping review”, S. Guruge, V. Jayasuriya-Illesinghe, N. Gunawardena, and J. Perera found that 70% of survivors of GBV accepted being beaten by the husband and thus tolerated such violence for decades. Gunathilake and Prof. Vidanapathirana noted therefore, due to this attitudinal issue, survivors usually appear at the Mithuru Piyasa at an extremely late stage, sometimes after having attempted suicide.
The management of a family problem involves a team comprising a psychiatrist, police officers attached to the district secretariats, a JMO, hospital administrators, representatives of the NCPA, a probation officer, and two trained counsellors (including one who is a trained nurse). The Mithuru Piyasa will also have a psychiatry unit with one medical officer assigned to deal with mental or psychiatric issues.
In terms of efficacy, in 2016, 2,328 counselling sessions were conducted with the “red dot” being identified in 440 cases, and problems being identified and resolved in 182 cases with the use of counselling, and psychiatric problems being identified and referred for treatment in 252 cases. However, three cases were deemed extreme, and the officers were unable to stop the separation and the matters were thence referred to the Legal Aid Commission. In such circumstances, the officers’ strategy is to allow the couple to separate peacefully and thereafter consider the future arrangements of their lives and that of their children.
The Mithuru Piyasa service is also open on Sundays. Anybody can enter it without any referral or notice.